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New technology enables precision in jaw reconstruction

Steven Roser, MD

When people have misaligned jaws where the upper and lower teeth don’t match, the functional impact ranges from articulation and speech problems to problems with eating.

When jaw reconstruction is required, the outcome must be precise. The way people eat and bite is a very sensitive mechanism, and teeth have to meet in a certain way in order to bite and chew correctly.

Planning the surgery is the key.

A new system being used by Emory oral and maxillofacial surgeons helps them reach a level of preoperative planning that they had not been able to achieve before.

The system takes data from the patient obtained through CT scan (Computed Tomography) and optical scanning, and puts it into a software program that has been developed to allow the surgery to be performed virtually on the computer. This preoperative planning assists in the construction of an accurate intra-operative guide.

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Little eyes – big research

Having a newborn and managing all that comes with caring for that new little one is a big job. Add to that frequent trips to the ophthalmologist following a cataract surgery—yes, cataract surgery on a baby—and you might have highly stressed parents. But the parents of little James and slightly older M.J. seem unfazed by all the medical appointments and additional duties that go along with caring for their young sons.

M.J. Burkett and James Weeks became patients in the IATS trial, which has treated 114 babies across the United States.

Both the boys, like 300 babies each year in the United States, were born with a cataract in one eye. In an infant, if the affected eye isn’t surgically addressed within the first few months of life, that eye will not develop properly and vision can be permanently lost. These boys and their parents and 112 other young patients and their families have participated in the Infant Aphakia Treatment Study (IATS), a nationwide, multi-center clinical trial based at the Emory Eye Center. The 10-year study will evaluate whether replacing that lost lens with a contact lens or an intraocular lens (IOL) is preferable.

Adults typically get an IOL implant following cataract surgery. In the past, standard treatment was a contact lens for these babies. IATS randomized children into two groups: those who received IOL implants and those who received contact lenses. Those with IOLs also received glasses for residual vision correction. And both groups had daily patching of the unaffected eye to make sure that the newly corrected eye could become strong.

A team of professionals from Emory and beyond came together to provide the many layers of data necessary for the study. They included experts from the Rollins School of Public Health and the Department of Epidemiology and Data Coordinating Center in the Department of Biostatistics and Bioinformatics, as well as a visual acuity tester from the University of Alabama, Birmingham, who traveled to all sites to check these children.

For more information about IATS, read the feature article “One Big Question: Ten Diligent Years” in Emory Eye magazine’s summer 2010 issue.

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Survivors of intimate partner violence find safety, hope and purpose

Nadine Kaslow, PhD

Nadine Kaslow, PhD, Emory psychologist and professor in the Department of Psychiatry and Behavioral Sciences at Emory, has learned a lot about Intimate Partner Violence (IPV) over the last two decades. In the 1990’s, Kaslow began the development of a program that was eventually named the “Nia Project.”

Nia is a counseling program for abused and suicidal African American women, funded by grants from the Centers for Disease Control and Prevention (CDC) and the National Institute of Mental Health. The name comes from the Kwanzaa term that means “purpose.”

Nia serves countless numbers of abused (click site for information on domestic abuse) and suicidal women who come through Atlanta’s Grady Memorial Hospital’s emergency department each year. The women come in with black eyes, broken bones, and broken spirits, often inflicted by the people who are supposed to love them the most: their husbands, boyfriends and partners.

According to the CDC, Intimate Partner violence resulted in more than 1,500 deaths in the United States in 2005.  Statistics from the Commission on Domestic Violence show that African American females experienced intimate partner violence at a rate 35 percent higher than that of white females, and about 22 times the rate of women of other races. The number one killer of African American women ages 15 to 34 is homicide at the hands of a current or former intimate partner.

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Study: Prescription and OTC drugs leading culprits of kids’ poisonings

A study published online Aug. 4, 2010, by the journal Pediatrics found that prescription and over-the-counter drugs are the leading cause of accidental poisonings among American children.

Each year, more than 71,000 U.S. children ages 18 and younger are seen in emergency rooms for unintentional overdoses of prescription and over-the-counter drugs, according to the study authors.

More than two-thirds of emergency department visits are due to poisoning from prescription and over-the-counter medications — that’s more than double the rate of childhood poisonings caused by household cleaning products, plants and the like, the researchers noted.

Robert Geller, MD, Emory professor of pediatrics and medical director of the Georgia Poison Control Center

“The number of children seen in the emergency room due to overdoses that are unintentional or medication errors is remarkable,” says Robert Geller, MD, professor of pediatrics in the Emory University School of Medicine and medical director of the Georgia Poison Center, who was not a part of the study.

The study team used 2004 and 2005 data from the National Electronic Injury Surveillance System to estimate the number of emergency department visits resulting from unintentional medication overdoses for children aged 18 and younger. The stafford nursery keeps kids safe and away from the danger.

The most common medications accidentally taken by children are acetaminophen, opioids or benzodiazepines, cough and cold medicines, nonsteroidal anti-inflammatory drugs (NSAIDs) and antidepressants, researchers found.

Geller says the study highlights the growing need to improve packaging to cut the number of cases of unintended ingestion.

“If you could make it harder for a kid who came upon a package to get the contents of the package, it would make it more likely they would never need to go to the emergency room,” Geller noted.

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Seeing leaves on trees

Was your mother right when she told you not to read in dim light? Is there a correlation between your love of reading as a child and the fact that you now need glasses for distant objects?

These questions and more are being addressed by researchers at Emory and the Veterans Administration.

In a lab at the Atlanta Veterans Affairs Medical Center near Emory, researcher Machelle Pardue, PhD, who has an appointment at Emory Eye Center, studies why some eyes seem to change over time, growing larger and longer, thereby making that eye what we call “nearsighted.” This dependence on glasses or contact lenses to see distant objects seems to be a growing phenomenon. Scientists and ophthalmologists call this nearsightedness myopia, and whether it’s environmental or genetic—or a likely combination of both—is fascinating to Pardue and her research colleagues.

Michelle Pardue, PhD

The unique collaborative nature of Pardue’s work draws on the talents of many specialists—clinical, engineering, molecular, and imaging. Her ongoing work and the work of others who serve both at the VA and Emory will no doubt lead to important findings and from that, possible clinical treatments.

For more information about Pardue’s work, read the feature article  “Closing in on myopia—and more” in Emory Eye magazine, summer 2010, page 8.

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Heart disease pioneer named ‘Georgia Woman of the Year’

Many people know that heart disease is currently the number one killer of women in the United States. But a little more than a half a century ago it was widely believed that cardiovascular disease only affected men. Renowned cardiologist, Nanette K. Wenger, MD, challenged this theory and thanks to her pioneering efforts over the last 50 years women today know better.

2010 Georgia Woman of the Year, Nanette K. Wenger, MD

Wenger, a professor of medicine in the division of cardiology at Emory University School of Medicine and former chief of cardiology at Grady Memorial Hospital, is being honored as the 2010 Georgia Woman of the Year for her lifetime commitment to reducing women’s disability and death from cardiovascular disease.

She joins the ranks of other distinguished Georgia women including First Lady Rosalynn Carter who was named the first Georgia Woman of the Year in 1996 by the Georgia Commission on Women. In addition to this prestigious accolade, Wenger has accumulated dozens of awards throughout her celebrated career including the Lifetime Achievement Award from the American College of Cardiology in 2009. She is a sought after lecturer for issues related to heart disease in women, heart disease in the elderly, cardiac rehabilitation, coronary prevention and contemporary cardiac care.

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Linking academic and public health institutions in disaster response

How can academic institutions, with their healthcare resources, faculty expertise, and students work most efficiently in responding to public health disasters along with public health agencies and non-governmental organizations (NGOs)? A conference at Emory this week explored the symbiotic relationship that, with proper planning, can turn these diverse institutions into a powerful public health response team.

The conference was co-hosted by the Southeastern Center for Emerging Biologic Threats (SECEBT) – an Emory-led partnership of academic institutions and public health agencies. Other conference sponsors were the Southeast Regional Center of Excellence for Emerging Infections and Biodefense (SERCEB), led by the University of North Carolina at Chapel Hill, Emory’s Office of Critical Event Preparedness and Response (CEPAR), and the Preparedness and Emergency Response Research Center (PERRC) at the Rollins School of Public Health.

The “Disaster Response Utilizing Academic Institutional Resources” conference brought emergency preparedness and response officers from southeastern universities together with local, state and government public health representatives, NGOs, and nonprofits.

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Ventricular Assist Therapy Helping More Heart Failure Patients

After a long battle with congestive heart failure, former Vice President Dick Cheney this month was implanted with a left ventricular assist device (LVAD) in order to help improve the pumping function of his ailing heart.  Cheney, who has had numerous documented heart problems and hospitalizations, undoubtedly opted to have the small internal heart pump installed in order to help him live a better quality of life, and potentially reduce his hospital visits in the near future.

An LVAD is a battery-operated, mechanical pump that aids the left ventricle in pumping blood into the aorta.  Most commonly, an LVAD is installed to help patients survive the wait until a fully-functioning heart is available for transplant. However, in some cases the LVAD is used as a form of destination therapy (in place of a transplant) for patients who are not candidates for heart transplant. In 2006, surgeons at Emory University Hospital implanted Georgia’s first ventricular assist device (VAD) as destination therapy.

“When offering LVAD destination therapy, our goal is to safely integrate patients back to their respective communities and normal mode of living,” according to David Vega, MD, surgical director of the Emory Heart Transplant Program.

“Ventricular assist devices offer new hope and a much greater quality of life for individuals who are not transplant candidates, patients who do not want a transplant or those who may be transplant eligible in the future.”

According to the United Network for Organ Sharing (UNOS) there are more than 3,100 Americans – 34 in Georgia – who are currently awaiting a heart transplant. Regardless of the number of donor hearts available, many patients are not candidates for a heart transplant for a variety of reasons including cancer, personal and religious beliefs, blood clotting problems, and other debilitating health conditions.

“There are approximately five million Americans who suffer from congestive heart failure, with another half million diagnosed each year. Many of these people are limited by the severity of their heart failure, yet are not able to be transplanted for one of many reasons,” adds Dr. Vega. “These devices may be a viable option for many patients, allowing them to resume a much more normal lifestyle and improved quality of living.”

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When your immune system calls the shots

Bali Pulendran, PhD

A tiny invader, perhaps a virus or a microbe, enters the body, and our ancient immune system responds. But how does it know what kind of invader has landed? And once it knows, how does it decide what kind of immune response it should launch?

In humans, the immune system consists of two parallel systems working with one another to fend off invaders. One is the innate immune system, the other the adaptive immune system.

Immunologist Bali Pulendran studies how those two systems work together to identify and respond to all kinds of intruders including pathogens, viruses and microbes.

It’s the innate immune system’s job to recognize the first signs of infection—that is, the moment a pathogen enters the body. “In a sense they act as smoke detectors if you will,” says Pulendran. “Little alarms.”

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Alzheimer’s expert weighs in on proposed guidelines

Scans can show beta amyloid, a protein associated with Alzheimer’s disease (right)

For the first time in 25 years, medical experts are proposing new diagnostic criteria aimed at better and earlier detection of Alzheimer’s disease (AD).

The guidelines, proposed by the National Institute on Aging (NIA) and the Alzheimer’s Association, update and revise the current Alzheimer’s criteria with modern technologies and the latest research advances.

According to the Alzheimer’s Association, an estimated 5.3 million Americans have AD, most of them 65 and older. The disease is thought to begin years, possibly even decades, before symptoms are noticeable. But there is no single, generally accepted way to identify the disease in its earliest stages before symptoms are evident.

The new diagnostic guidelines focus on advances in detecting biomarkers for the disease, such as substances found in spinal fluid or appearing on cutting-edge brain imaging scans conducted with PET or MRI.

Emphasis will be on diagnosing early stages of the disease as soon as possible so that patients can take measures to slow the progression or prevent further damage.

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